| Allergen specific IgE each allergen CPT 86003 • Allergy | $7 | $7 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $11 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $8 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $10 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $21 | $29 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $6 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $14 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $17 | $25 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $16 | $31 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $38 | $38 | $38 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $38 | $40 | $41 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $38 | $40 | $41 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $38 | $38 | $38 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $38 | $204 | $537 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $253 | $691 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $38 | $40 | $41 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $38 | $39 | $41 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $38 | $39 | $41 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $38 | $422 | $614 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $38 | $39 | $41 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $38 | $38 | $38 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $38 | $39 | $41 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $41 | $860 | $2,874 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $41 | $1,958 | $4,991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $41 | $4,020 | $10,308 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,005 | $4,568 | $12,121 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $41 | $4,532 | $13,514 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $545 | $957 | $1,782 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $605 | $1,292 | $1,978 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $21 | $28 | $41 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $12 | $14 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $13 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $94 | $134 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $53 | $77 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $115 | $173 | $289 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $75 | $194 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $41 | $160 | $230 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $255 | $411 | $723 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $41 | $117 | $347 |
| Stress echocardiography CPT 93350 • Cardiology | $41 | $253 | $528 |
| Left and right heart catheterization CPT 93452 • Cardiology | $841 | $1,227 | $1,613 |
| Left heart catheterization CPT 93458 • Cardiology | $1,033 | $1,084 | $1,134 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,180 | $1,857 | $3,744 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $170 | $252 | $385 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $122 | $142 | $183 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $152 | $247 | $494 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $152 | $302 | $453 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $38 | $63 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $38 | $47 | $63 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $90 | $99 | $109 |